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<!DOCTYPE html>
<html>
    <head>
        <meta http-equiv="Content-Type" content="text/html; charset=UTF-8">
        <title></title>
    </head>
    <body>
        <form METHOD="POST" ACTION="/ONG/index.php?controller=Contacto&action=insert" class="contact-form" name="contactform" >
        <table width="100%" border="1">
        	<tbody><tr><td width="40%" style="vertical-align:middle;"><label>First Name *</label></td><td width="60%"><input type="text" name="nombre" class="textfield" value=""></td></tr>
            <tr><td width="40%" style="vertical-align:middle;"><label>Last Name *</label></td><td width="60%"><input type="text" name="apellidos" class="textfield" value=""></td></tr>
            <tr><td width="40%" style="vertical-align:middle;"><label>Gender *</label></td><td width="60%"><input type="radio" name="sexo" checked="checked" value="1">Male &nbsp;&nbsp;&nbsp;<input type="radio" name="sexo" value="0">Female<br><br><br></td></tr>
            <tr><td width="40%" style="vertical-align:middle;"><label>Program of Interest *</label></td><td width="60%"><input type="text" name="programa" class="textfield" value=""></td></tr>
            <tr><td width="40%" style="vertical-align:middle;"><label>University  *</label></td><td width="60%"><input type="text" name="universidad" class="textfield" value=""></td></tr>
            <tr><td width="40%" style="vertical-align:middle;"><label>Email Address *</label></td><td width="60%"><input type="text" name="email" class="textfield" value=""></td></tr>
            <tr><td width="40%" style="vertical-align:middle;"><label>Cell Phone Number  *</label></td><td width="60%"><input type="text" name="celular" class="textfield" onkeypress="return justNumbers(event);"></td></tr>
            <tr><td width="40%" style="vertical-align:middle;"><label>Country  *</label></td><td width="60%"><input type="text" name="pais" class="textfield" value=""></td></tr>
            <tr><td width="40%" style="vertical-align:middle;"><label>Address </label></td><td width="60%"><input type="text" name="direccion" class="textfield" value=""></td></tr>
            <tr><td width="40%" style="vertical-align:middle;"><label>Comments / Inquiries *</label></td><td width="60%"><textarea name="comentario" id="message" class="textarea" cols="2" rows="2"></textarea></td></tr>
        </tbody></table>
        <div style="float:right; margin-right:50px;">
             <input type="submit" name="Send" value="Send">
        </form>
        
        <script type="text/javascript"> 
            function justNumbers(e) {
                var keynum = window.event ? window.event.keyCode : e.which;
                if ( keynum == 8 ) return true;
                return /\d/.test(String.fromCharCode(keynum));
            } 
        </script> 

    </body>
</html>
